BCM
Gastroenterology Grand Rounds - Take Home Lessons
The main lessons to take home concerning this case
are:
1. CT has a higher overall sensitivity than MR and transabdominal
sonography for detection of focal hepatic metastases. When the results
of the three procedures are combined, the overall sensitivity is close
to 80%. This is unsatisfactorily low because CT and MR have a size threshold
of about 1.0 cm and are relatively unreliable for detection of smaller
lesions.
2. EUS can detect small focal liver lesions that are
not detected at CT. Findings of EUS-FNA can confirm a cytologic diagnosis
of liver metastasis and establish a definitive M stage that may change
clinical management.
3. EUS and EUS-FNA may be capable of diagnosing early
recurrences of various malignant lesions including hepatocellular carcinoma
at a stage at which surgery can still be curable.
4. The exact role of EUS to identify nad sample hepatic
lesions is still being studied.
